Fluid and Electrolyte Imbalance Electrolytes, or ions, are the charged particles in body fluids that help transmit electrical impulses for proper nerve, heart, and muscle function. The number of positive ions, called cations, and negative ions, called anions, is supposed to be equal. Anything that upsets this balance can have life-threatening consequences.
Maintaining the right balance of electrolytes is essential in maintain homeostasis. Fluid and electrolyte imbalances occur in most patients with a serious illness or injury because illness disturbs the normal homeostatic mechanism. Sometimes these imbalances are caused by illness but they can also be secondary to treatment of illness Sodium, calcium, potassium, chlorine, phosphate and magnesium are all electrolytes however problems most often occur with changes in levels of sodium, potassium or calcium. Common Complications for Cancer patients related to Electrolyte Imbalances Hypercalcemia
Polyuria/ polydipsia
Stomach Pain
Anorexia
Constipation
Acute CNS changes
Lethargy
Paranoia
Confusion
Depression
Somnolence to coma
Treatment of Hypercalcemia
Promotion of excretion of calcium in the urine by administration of loop diuretic( Lasix)
Administer Isotonic Saline Infusions
Push fluids 3000 to 4000ml of fluids per day to promote renal excretion of calcium and decrease risk of kidney stones
Hypocalcemia Hypocalcemia based on total calcium measurement is frequent in certain cancers (especially prostate and hematologic cancers) in association with osteosclerotic bone metastases. In a majority of these patients hypocalcemia is related to the low serum albumin and/or renal failure. True ionized hypocalcemia may be seen as a toxic effect of certain chemotherapeutic agents or as a consequence of hyperphosphatemia due to rapid tumor lysis
Acute CNS Changes
Lethargy
Confusion
Depression
Seizures
Dry Skin
Low Blood Pressure
Tingling in fingers and toes
Muscle spasms / aches
Difficulty breathing
Vision changes
Treatment of Hypocalcemia
Oral or IV Calcium Supplemnts
Hyponaturemia Symptoms
Nausea and vomiting
Headache
Confusion
Loss of energy
Fatigue
Restlessness and irritability
Muscle weakness, spasms or cramps
seizures
somnolence to coma
Treatment of Hyponaturemia
Fluid replacement with sodium containing solutions
Hyperkalemia Hyperkalemia is occasionally induced by chemotherapy for very large malignant tumors, due to tumor lysis syndrome. Symptom
Abnormal heartbeat
Weak or absent pulse
Muscle weakness
Nausea
Fatigue
Treatment of Hyperkalemia
Eliminate Oral and Parenteral potassium intake
Educate/ provide list of potassium containing foods
Increase elimination of Potassium via , diuretic, dialysis, kayexalate
Increase fluid intake
Drug therapy( Insulin, epinephrine,)
Calcium Gluconate
Client Education and General Treatment
Drug and diet protocols specific to imbalance
General
Maintain fluid intake
- Take nutritional supplements as prescribed
Administer antiemetics prior to surgery
Regularly monitor lab values
Monitor for diarrhea, constipation, nausea, vomiting
Oncologic Emergencies: Diagnosis and Treatment SYMPOSIUM ON ONCOLOGY PRACTICE: HEMATOLOGICAL MALIGNANCIES THORVARDUR R. HALFDANARSON, MD; WILLIAM J. HOGAN, MBBCH; AND TIMOTHY J. MOYNIHAN, MD.
Electrolytes, or ions, are the charged particles in body fluids that help transmit electrical impulses for proper nerve, heart, and muscle function. The number of positive ions, called cations, and negative ions, called anions, is supposed to be equal. Anything that upsets this balance can have life-threatening consequences.
Maintaining the right balance of electrolytes is essential in maintain homeostasis.
Fluid and electrolyte imbalances occur in most patients with a serious illness or injury because illness disturbs the normal homeostatic mechanism. Sometimes these imbalances are caused by illness but they can also be secondary to treatment of illness
Sodium, calcium, potassium, chlorine, phosphate and magnesium are all electrolytes however problems most often occur with changes in levels of sodium, potassium or calcium.
Common Complications for Cancer patients related to Electrolyte Imbalances
Hypercalcemia
Treatment of Hypercalcemia
Hypocalcemia
Hypocalcemia based on total calcium measurement is frequent in certain cancers (especially prostate and hematologic cancers) in association with osteosclerotic bone metastases. In a majority of these patients hypocalcemia is related to the low serum albumin and/or renal failure. True ionized hypocalcemia may be seen as a toxic effect of certain chemotherapeutic agents or as a consequence of hyperphosphatemia due to rapid tumor lysis
Treatment of Hypocalcemia
Hyponaturemia Symptoms
- Nausea and vomiting
- Headache
- Confusion
- Loss of energy
- Fatigue
- Restlessness and irritability
- Muscle weakness, spasms or cramps
- seizures
- somnolence to coma
Treatment of HyponaturemiaHyperkalemia
Hyperkalemia is occasionally induced by chemotherapy for very large malignant tumors, due to tumor lysis syndrome.
Symptom
Treatment of Hyperkalemia
Client Education and General Treatment
References
http://www.ncbi.nlm.nih.gov/pubmed/20567101?log$=activity
http://www.mayoclinic.com/health/DiseasesIndex/DiseasesIndex
Medical-Surgical Nursing: Assessment and Management of Clinical Problems 7th edition, Lewis 2007
Oncologic Emergencies: Diagnosis and Treatment
SYMPOSIUM ON ONCOLOGY PRACTICE: HEMATOLOGICAL MALIGNANCIES
THORVARDUR R. HALFDANARSON, MD; WILLIAM J. HOGAN, MBBCH; AND TIMOTHY J. MOYNIHAN, MD.
Additional Resources
Glauser, MD, Jonathan. "Oncologic Emergencies." Emergency Medicine Reports 30.8 (2009): 90-99. Www.emreports.com . Web.
http://www.cancer.org/Treatment/UnderstandingYourDiagnosis/ExamsandTestDescriptions/understanding-your-lab-test-results
http://www.caring4cancer.com/go/cancer/effects/lesscommon/electrolyte-imbalance.htm
http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=158213